Just how smart are you with your money?

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The Future is coming, whether you like it or not. In fact, some parts are going to be very ben_franklinpositive, and some aren’t. You have to be prepared to deal with both. The sooner you start to prepare, the lower your costs will be!

We like to think about buying a house, buying a car, fancy weddings, babies and graduations. We don’t like to think about down payments, maternity costs or paying for college. However, as economist Milton Friedman famously wrote, “there’s no such thing as a free lunch.”

The statistics are simple.

  • The average life expectancy (LE) in the US is 78.8 years (1) — shorter for the poor and Southerners; longer for women and the affluent.
  • The healthy life expectancy (HLE) in the US is 68.1 years. By comparison, the HLE for Bosnia is 68.8 years and for Canada it’s 72.3 years. (3) HLE in the US varies by state and is shorter for Southerners. (2)
  • The difference between LE and HLE is the amount of time you can expect to have to deal with some kind of physical impairment. In the US, that amounts to a decade of trouble on average.

A new study confirms what people with elder parents already knew: older people need help with daily living. Even if they are fairly independent, both finances and medications can get out of control. They may not have or want to be dependent on family members to manage either.

Over 10 years, 10.3% of those aged 65 to 69 needed help managing medications and 23.1% needed help managing finances. These rates rose with age, to 38.2% and 69%, respectively, in those over age 85. Women had a higher risk than men, especially with advancing age. Additional factors linked with an increased risk for both outcomes included a history of stroke, low cognitive functioning, and difficulty with activities of daily living. (4/5)

There are resources, but they aren’t free.

  • The average cost of in-home healthcare in the US is $3,600 per month, as I mentioned in a prior blog. The average cost of a nursing home is $9,200 per month. Medicare can pick up the first 100 days. One of the Trump proposals for Medicaid reform involves eliminating Medicaid as a way to deal with these expenses.
  • There is a  category of professional, “daily money managers.” These aren’t financial planners, but they deal with records management, budgeting, checking the validity of expenditures, and bill payment. Costs for these services vary but can start at around $450 per month. (6) Not only do they keep things together for their clients, they are an important line of defense against scammers preying on seniors.

So, how are your parents going to deal with this? How are you going to deal with this when it’s your turn?

These problems are  best addressed when you do what most people don’t — act early on them.

  • Set aside dedicated savings for retirement.
  • Purchase permanent life insurance with a rider that allows you to take up to 50% of the face value of the policy for disability and long term care expenses. (7)

Both of these actions are best done earlier in life rather than later

  • Starting savings early allows the most time for compounding of interest.
  • Starting life insurance early minimizes cost. Insurance premiums are directly related to the length of time the carrier expects to have your money before they have to pay out. The earlier you buy, the less it will cost and the more you can afford. For example —
    • In NJ, for a woman age 24 non-smoker, a new $200,000 whole life policy might cost $113.68 per month.
    • In NJ, for a woman age 44 non-smoker, the same policy would cost $365.08 per month.
    • In NJ, for a woman age 59 non-smoker, a new $100,000 policy would cost $395.08. From the carrier used to quote these examples, a $200,000 whole life policy would not be available for someone that age.

With age, the price goes up and what you can buy goes down.

Procrastination costs you money. Don’t put this off.

If you practice a healthy life style, you can try to minimize the gap between LE and HLE, but you can’t count on eliminating it. There are just too many factors outside of your control (e.g., ice, drunk drivers, pollution, etc.).

 


Sources:

  1. Centers for Disease Control and Prevention, “FastStats,” 17 March 2017. https://www.cdc.gov/nchs/fastats/life-expectancy.htm
  2. Centers for Disease Control and Prevention, “State-Specific Healthy Life Expectancy at Age 65 Years — United States, 2007–2009,” 19 July 2013. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6228a1.htm#fig1
  3. World Health Organization, “Healthy Life Expectancy at Birth — 2000 to 2015,” http://gamapserver.who.int/gho/interactive_charts/mbd/hale_1/atlas.html
  4. Nienke Bleijenberg, Alexander K. Smith, Sei J. Lee, Irena Stijacic Cenzer, John W. Boscardin, Kenneth E. Covinsky. Difficulty Managing Medications and Finances in Older Adults: A 10-year Cohort Study. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14819
  5. Wiley. “Many older adults will need help with managing their medicines and money.” ScienceDaily. ScienceDaily, 7 April 2017. <www.sciencedaily.com/releases/2017/04/170407113035.htm.
  6. For those in the NJ area, I have a friend, Nancy Sobin, who offers these services. Please see her at http://paperwork-services.com/. She belongs to the American Association of Daily Money Managers, http://www.aadmm.com/.
  7. There are some companies that offer these riders for term insurance, which is much less expensive than permanent. The problem is that term insurance typically terminates by age 65, and home or nursing home care expenses typically start after that age. There’s no point having a rider that’s not going to be in force when you need it.

More on Strep Throat

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This isn’t Halloween, and this story isn’t funny.  Here’s the short version:strepthroat_456px

  • Father contracts step throat in early March.
  • Family is tested for strep.
  • Six-year old daughter has bacteria even though she has shown no symptoms, and is given a ten-day course of antibiotics.
  • Daughter starts exhibiting flu-like symptoms on March 25th, and is misdiagnosed has having Influenza A.
  • On March 27th, she has pain and swelling on left leg, and is rushed to Arkon Children’s Hospital. She is now diagnosed with necrotizing fasciitis, commonly referred to as flesh-eating bacteria.
  • Her leg is amputated below the knee.

Strep throat normally affects the tonsils and throat. The cause is Streptococcus bacteria. If the bacteria enters the bloodstream, it can then cause necrotizing fasciitis, which is life threatening.

What the CDC says about how you get strep:

Strep throat is an infection in the throat and tonsils caused by group A Streptococcusbacteria (called “group A strep”). Group A strep bacteria can also live in a person’s nose and throat without causing illness. The bacteria are spread through contact with droplets after an infected person coughs or sneezes. If you touch your mouth, nose, or eyes after touching something that has these droplets on it, you may become ill. If you drink from the same glass or eat from the same plate as a sick person, you could also become ill. It is also possible to get strep throat from touching sores on the skin caused by group A strep. (2)

This is the third published report in recent weeks about amputations related to strep.

What you need to consider:

  • Strep bacteria can live in the nose for weeks without symptoms. It’s possible that a saline nasal spray may help reduce the risk of infection or ease symptoms once infection starts.
  • If someone in your family gets it, everyone needs to be tested. Same for the workplace.
  • Don’t expose others to strep unnecessarily. Stay home from work or school.

Sources:

  1. Brian Zimmerman, “6-year-old loses leg after complication from strep throat,” Becker’s Infection Control and Clinical Quality, 5 April 2017. http://www.beckershospitalreview.com/quality/6-year-old-loses-leg-after-complication-from-strep-throat.html
  2. Centers for Disease Control and Prevention, “Worried your sore throat may be strep?” https://www.cdc.gov/features/strepthroat/
  3. eMedicine Health, “Strep Throat: Home Treatment.” http://www.emedicinehealth.com/strep_throat_home_treatment-health/article_em.htm

Photo courtesy CDC website.

Diagnostic Errors

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Facts to consider:

  • 10% of initial medical diagnoses are wrong and contribute to between 40,000 and 80,000 deaths in the US each year. That’s comparable to annual deaths from breast cancer. (2)
  • According to a study by Johns Hopkins, 13% of stoke victims on their initial visit to an ER are sent home without proper diagnosis or treatment. (1)

What you need to consider:

  • Every patient needs an advocate, especially if the patient is unable to express his or her concerns.
  • Doctors are human and humans make mistakes. If the doctor’s diagnosis doesn’t feel right, push back.
  • If it’s important, get a second opinion from an independent medical professional.

Sources:

  1. Merrill Goozner, “Editorial: Diagnosing Wisely,” Modern Medicine, 25 September 2015 (republished, 6 April 2017). http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269984
  2. Society to Improve Diagnosis in Medicine. http://www.improvediagnosis.org/

A vaccine for colon cancer?!

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Thomas Jefferson University Hospital is on a roll.  Wow.

This time it’s immunotherapy for colon cancer. As the ACS notes, this is only one of several improvements in cancer treatment now in the works.  However, it might be a particularly important one.

A drug developed by researchers at the Hospital is about to enter Phase II clinical trials. Here’s the story:

After identifying the Guanylate Cyclase C enzyme in the early 1990s, Scott Waldman, MD, and Adam Snook, MD, are set to take a vaccine that targets the enzyme to destroy metastatic tumors to a phase II trial in 2017.

Here’s what you should know.

1. Dr. Waldman and Dr. Snook are both professors at Thomas Jefferson University in Philadelphia, and Dr. Waldman is the chair of the department of pharmacology and experimental therapeutics.

They reported the enzyme has been “shown to be highly accurate for detecting the spread and predicting recurrence of colorectal cancer.” The duo’s vaccine instructs the immune system to stop metastatic tumor cells and destroy them.

2. Dr. Waldman said the preliminary findings on the vaccine “mean we have the potential to limit the aggressive nature of this disease and prevent metastases.”

3. Exton, Pa.-based Targeted Diagnostics & Therapeutics holds the rights to the drug and has supported the work in Dr. Waldman’s lab.

4. After 15 years of research and several lab and animal-based studies, Dr. Waldman’s new drug application was approved by the FDA in 2013. His phase I trial tested the safety and tolerability of the drug in stage I and II cancer patients. It was safe and well-tolerated.

5. Dr. Waldman recently secured funding for a phase II trial. It’s set to take place in 2017, pending FDA approval. It will assess the vaccine’s effectiveness with intent of commercializing the vaccine. The trial will take two years.

6. If the trial can show efficacy, the physicians will seek Orphan Drug Status to “fast-track” it to the market.

In short, the drug identifies colon cancer cells to the body’s immune system for attack. The Phase I trial established that the drug itself would do no immediate harm to the patient. Phase II will assess how effective it is.

What you should consider:

  • IF the drug works as it appears to, trials like this can be lifesavers for patients with advanced colon cancer. 
  • Do you know someone who might want to participate in the trial?

Sources:

  1. Eric Oliver, “Metastatic tumor-destroying vaccine for colon cancer patients to begin phase II trial: 6 key notes,” Becker’s GI and Endoscopy, original date, 16 November 2016, (re)published 4 April 2017. http://www.beckersasc.com/gastroenterology-and-endoscopy/metastatic-tumor-destroying-vaccine-for-colon-cancer-patients-to-begin-phase-ii-trial-6-key-notes.html
  2. Viral Gene, Inc., “Viral Gene Announces Breakthrough in Colon Cancer: New Vaccine Targets Enzyme to Help Destroy Metastatic Tumor Cells,” press release, 22 November 2017. http://www.prnewswire.com/news-releases/viral-gene-announces-breakthrough-in-colon-cancer-new-vaccine-targets-enzyme-to-help-destroy-metastatic-tumor-cells-300366844.html
  3. American Cancer Society, “What’s new in colorectal cancer research?” 1 March 2017. https://www.cancer.org/cancer/colon-rectal-cancer/about/new-research.html

Unnecessary stents?

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Thomas Jefferson University Hospital comes through again.

Do you really want a surgery you don’t need?

Coronary artery disease (CAD) is the most common form of heart disease in the US, and hd-coronary-adkills over 370,000 Americans each year. It involves a blockage in an artery carrying blood to the heart and can cause damage to the heart muscle and death.

The common form of treatment for a blocked coronary artery is a balloon angioplasty, and procedure that uses an endoscope to move a balloon to the blockage and inflate it, increasing the width of the artery and allowing blood to flow. The procedure may include placement of a stent to keep the artery open permanently. It’s a simple procedure and fairly common.

There are risks to the procedure, and about 3.3% of patients die. Risks include blood clots that can originate at the site of the blockage and travel to organs or the brain.

Oddly, while heart disease can occur anywhere in the US, it is most common in the Southheart_disease_deaths.png and lower Midwest, in states including Kentucky, Alabama, Mississippi, Arkansas, Louisiana and Oklahoma. What people eat in this region may put them at particular risk.

Doctors at Jefferson have found that some doctors mistake “coronary spasms” for CAD. The Jefferson team routinely treat patients with nitroglycerin prior to placing a stent, and noticed that for some patients, the nitroglycerin was sufficient to solve the patient’s medical issues.  The stent was unnecessary.

Their conclusion is that some angioplasties may be unnecessary.

According to Michael Savage, M.D., Director of the Jefferson Angioplasty Center and senior author of the report:

“Interventional cardiologists [cardio surgeons] should be especially suspicious of coronary artery spasm when they encounter a patient under the age of 60 with disease isolated to a single vessel. We recommend that future guidelines include intracoronary nitroglycerin for these patients.” (5)

However, nitroglycerin is not now part of treatment guidelines.  Thus the concern that some people are being put through surgeries that are of no value to them, and incur unnecessary cost and risk.

The surgery is of no value for artery spasms, as these can easily recur at a different place in an artery after the stent is installed.


Sources:

  1. US Centers for Disease Control and Prevention, “Coronary Artery Disease (CAD).” https://www.cdc.gov/heartdisease/coronary_ad.htm
  2. US Centers for Disease Control and Prevention, “Heart Disease facts.” https://www.cdc.gov/heartdisease/facts.htm
  3. Steve Sternberg and Geoff Dougherty, “Angioplasty: Risks and Benefits,” US News, 11 February 2015. https://www.usnews.com/news/articles/2015/02/11/angioplasty-risks-and-benefits
  4. Vishnevsky, A., et al. Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines. Catheterization and Cardiovascular Interventions, March 2017 DOI: 10.1002/ccd.27034
  5. Thomas Jefferson University. “A simple fix to avoid unnecessary coronary stents is overlooked by cardiologists and current cardiovascular guidelines.” ScienceDaily. ScienceDaily, 20 March 2017. <www.sciencedaily.com/releases/2017/03/170320125633.htm>.

 

Flame retardants, household dust, and thyroid cancer

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A new report from Duke University finds an explanation for increases in the frequencyth of thyroid cancer in household dust.

“Thyroid cancer is the fastest increasing cancer in the U.S., with most of the increase in new cases being papillary thyroid cancer” [PTC], said the study’s lead investigator, Julie Ann Sosa, M.D., MA, professor of surgery and medicine at Duke University School of Medicine in Durham, N.C. “Recent studies suggest that environmental factors may, in part, be responsible for this increase.” (1)

Prior studies have shown that some flame retardants used in the home and in vehicles have a similar chemical structure to thyroid hormones and can disrupt thyroid function.

The study measured the content of household dust as well as the incidence of chemicals in blood samples taken from occupants.  The study used a post facto experimental design with test and control groups.  All of the 140 participants lived in their homes for more than 11 years.

This study established that these flame retardants

  1. Appear in household dust in measurable quantities, where they can be inhaled by occupants and
  2. The level of two of them found in dust and blood samples are associated with the probability of having PTC.

The two problem chemicals identified in the study as elevating cancer risk belong to a class of chemicals, polybrominated diphenyl ethers (PBDEs).

  • Decabromodiphenyl ether (BDE-209). This is the most commonly used retardant, and appears to double the risk for thyroid cancer.
  • Tris(2-chloroethyl) phosphate (TCEP).

Participants with high levels of TCEP in their house dust were more than four times as likely to have larger, more aggressive tumors that extended beyond the thyroid, according to the study.

Participants with high levels of BDE-209 in their blood were 14 times more likely to have a version of the cancer that tends to be more aggressive.

Why should you care?  These chemicals are used as flame retardants in plastics (including TV cabinets), furniture, drapery backing, some carpets and in consumer electronics, both in home and in automobiles.  Both exposure to these chemicals and the prevalence of thyroid cancer are increasing.

Note:  This research was funded by Fred and Alice Stanback, the Duke Cancer Institute, and the Nicholas School of the Environment at Duke University, and not by industry sources.

What you need to consider:

  • Do you have a home air purification system? Not something that makes the air smell nice, but something that removes dust and other particles from what you breath. Maybe it’s time to invest or upgrade.
  • Read the labels on what you buy.

 


Sources:

  1. The Endocrine Society. “Exposure to common flame retardants may raise the risk of papillary thyroid cancer.” ScienceDaily. ScienceDaily, 2 April 2017. <www.sciencedaily.com/releases/2017/04/170402111311.htm>.
  2. US Environmental Protection Agency, “Technical Fact Sheet — Polybrominated Diphenyl Ethers (PBDEs) and Polybrominated Bophenyls (PBBs),” January 2014.
  3. Wikipedia, “Decabromodiphenyl ether.” https://en.wikipedia.org/wiki/Decabromodiphenyl_ether

Lung Cancer and Women

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Media attention doesn’t necessarily reflect what’s most important to you.  Consider this comparison, based on 2016 statistics from the American Cancer Society and the National Cancer Institute:

Cancer type               Estimated number of new cases         Estimated number of deaths

Breast cancer                               252,710                                                 40,610

Lung cancer                                 222,500                                                155,870  (1)

Lung cancer accounts for just over 9% of deaths from all types of cancers.

Which should worry you more?

Understand that you don’t have to be female to contract breast cancer, and you don’t have to be a smoker to contract lung cancer.  Pollution is sufficient.

Early detection is best for both types of cancers. For breast cancer, you look for a lump. The test is easy. If you have a cat or dog, the animal may even paw at the area of the lump. You just need to look.

For lung cancer, the only early sign is a persistent dry cough — something that just doesn’t go away in a week or two, the way the cough associated with a cold should.  If the cough brings up blood, that’s a red flag, but the persistent cough by itself should prompt a visit to the doctor — sometimes visits to multiple doctors to get the diagnosis right.

Unfortunately, the dry cough is easy to ignore, and that’s when people get into trouble. By the time other symptoms appear, the cancer may have spread and be much more difficult to treat successfully. The five-year survival rate for Stage IV lung cancer is less than 10%. When one friend of mine finally was diagnosed, he lasted only a few months.

Listen to your body.


Sources:

  1. National Cancer Institute, “Common Cancer Types.” https://www.cancer.gov/types/common-cancers
  2. Centers for Disease Control and Prevention, “Statistics for Different Kinds of Cancers.” https://www.cdc.gov/cancer/dcpc/data/types.htm
  3. Amy Marturana, “The one very subtle symptom of lung cancer you need to know,” Self, 20 May 2017. https://www.aol.com/article/lifestyle/2017/03/20/subtle-symptom-lung-cancer/21903320/
  4. LungCancer.org, “Symptoms of Lung Cancer.” http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/266-symptoms